Time banking - an opportunity to co-produce better mental health? - Issue Papers

Time banking - an opportunity to co-produce better mental health?

What are time banks?
SOMETIMES medicine isn't enough to heal - and it isn't what people actually need. This was the initial idea behind the Rushey Green Time Bank, in Lewisham in South East London which operates out of a primary health care centre.

Time Banks arrived in this country from the USA about two years ago, where there are over 400 schemes up and running. They were the brainchild of retired law professor Edgar Cahn who found himself in hospital after suffering a severe heart attack. Feeling useless for the first time in his life, Edgar realised that he had joined countless others - older people, people with disabilities or mental illness - who are deemed as having nothing of value or worth to contribute.

Edgar resolved to create a way for himself along with countless others to make a contribution and have it counted. His idea was to get those who are judged to be most needy to ‘earn’ the help they need - by giving help to others. Everyone’s contribution would be measured in the one commodity everyone has - time and everyone’s time would be of equal worth.

Through a ‘time bank’ members ‘earn’ their time credits participating in a range of services and draw back that time when they needed help themselves. Each time bank has a broker who matches up member’s wants and offers and keeps the time ‘accounts’.

The underpinning belief behind time dollars or time banks is that in order to produce successful public services - everything from housing to health - it’s the users who hold the key to success. Without their involvement community enterprises will fail to engage and become really effective.

Time banks offer one way to secure this vital involvement. By recognising the skills and energies people have to give in the places where they live, learn or work - time banks encourage us to move towards a rather different model of producing public services through what Edgar calls ‘co-production’.

Time banks and health
New Economics Foundation (NEF) had the opportunity to pilot the time bank approach in 1999 with the support of the King’s Fund and in collaboration with a GP’s practice in Lewisham, South East London.

The Rushey Green Central Clinic serves over 6,000 people - stretching from Ladywell in the south to Catford in the north. The clinical team is made up of GPs, district nurses and a range of health practitioners - from psychologists to counsellors. The practice serves large Afro-Caribbean and Turkish communities. A growing number of patients are also refugees and those recently moved to the area for work.

GP Richard Byng and his team decided to experiment with the time bank approach because they were tired of prescribing for problems they knew were social rather than medical in origin. Much of their patients' ill-health and anxiety arose from feelings of social isolation - not knowing where to go for help, not knowing their neighbours, as one patient described it: "being too frightened to leave my own home". Health visitor Mercynth Johnson described how many of the families she worked with were in desperate need of practical support. "Support for the small things," was how GP Anne Hampton put it.

Their idea was to create a time bank, where patients could provide support and help from eachother. Ultimately GP’s, where appropriate would be able to prescribe time credits rather than medication. Equally time bank members would be encouraged to ‘earn’ their credits contributing their skills and energies in a whole variety of ways.

The Rushey Green Story
Exploring patients needs - and abilities
The starting point for the time bank was to find out from the people using the practice whether they thought the idea was feasible. NEF time bank worker Sarah Burns spent the next three months talking to patients in the waiting room area. First recruits Gladys and Nessrine joined a core of patients who backed the project and began earning their credits by going to visit people who were more frail or housebound to find out what they would like to contribute to the bank and what they would like to draw out.

Shifting to Can-Do
By using a cartoon questionnaire that covers skills and hobbies - everything from cooking to dj-ing we found that within the practice there was a vast amount of unutilised skills - especially among older people that could be harnessed for the better of patients. What was lacking was the support and contacts to share this wealth of talents. The time bank offered an ideal outlet.

We found that the most popular requests were help with small errands, letter writing and form filling, simple home repairs and companionship. And because the time bank is a way of giving as well as getting help, people offered everything from "someone to go to the pub with", to "help growing your own fruit and vegetables". Remarkably, young parents and older people shared many of the same needs for informal, low-level practical support.

Getting together
By the end of the summer, the first 20 members of the time bank came together to give the small practice garden an overhaul. The garden was hopelessly overgrown and although it affected everyone, nobody had ever done anything about it. The garden only reinforced what a lot of local people already thought - the neighbourhood and the people in it were in a bad state and nobody really cared.

But through the time bank, we had found a group of people who did care. Families and older people brought plants, seeds and food and together cleared and re-planted the garden. The gardening party was the first time people had got together at the practice and it provided the momentum for them to get together and help each other over the autumn and winter.

Creating a vision
During the summer and early autumn of 1999 time bank members and health workers also created a vision of the kind of healing centre they wanted to create through the time bank. These were some of the things they said they wanted to develop:

Starting small
Once we had created a shared vision for the time bank across the practice we could move forward together. We started small with members earning credits for giving companionship or telephone support to neighbours and spending credits on home repairs or trips out. The most important thing at this stage was to build members confidence in their ability to get active and help others. Many people when first approached were adamant that they had nothing of value to give. This was particularly the case with people with mental health needs. However with the right support these same people started visiting their neighbours, running a telephone ‘home form hospital’ scheme and checking on elderly carers.

Linking people up
At the beginning of this year, Liz Hoare joined the time bank team as part time co-ordinator. Her job is to match members up and provide support and follow up. She also keeps the time accounts by using the TimeKeeper software (available free from www.timemoney.org.uk). Liz’s biggest surprise was that the highest earners were those same people who seemed to have the least to give in more conventional terms. Time bank members earn credits -
Running poetry workshops, taking part in diabetes self help group, telephone befriending, making and sharing meals, going swimming and walking together, making toys for the toy library, flower arranging - anything that they enjoy sharing together.

Sharing knowledge - and power
One way in which health workers and the practice are able to earn their time credits is by training up time bank members. In this way ‘expert’ knowledge, for example about managing diabetes or depression trickles down to the real experts who need that knowledge on a daily basis. Initial findings show that members are more able to approach a peer for help - someone who has similar experiences than a specialised nurse or health worker.

Measuring the difference
Rushey Green Time Bank is being evaluated along three key dimensions: Impact on members self-perception of health; on their ability to get support when and where they need it and their ability to access preventative health care rather than emergency help. Members earn time credits for taking part in the evaluation and all findings are shared through the bank. This way members know that they are making a difference to themselves - and to others.

Participation and health
Valuing and measuring the contribution people make to their own health as well as to the health of those around them is a simple idea. What is extraordinary is that people are so rarely asked for their contribution. As professionals continue to service the needs of the most ‘needy’ amongst us - the implicit message they give out is “you have nothing of value that we need.”

In fact the absolute opposite is true. It is the contribution of these very people that make the difference between health service which continue to service people’s needs and one which transforms these needs into potential assets and capabilities that enrich us all.

More information:

Sarah Burns,
Time Bank Programme Manager,
New Economics Foundation,
Cinnamon house,
6 - 8 Cole Street,
London SE1 4YH.
Tel: 02027 407 7447
e-mail: sarah.burns@neweconomics.org
website: www.timemoney.org.uk